Provider Demographics
NPI:1962511543
Name:KRONGOLD, STEVEN JAY (DPM)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:JAY
Last Name:KRONGOLD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9961 NW 58TH CT
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33076-2549
Mailing Address - Country:US
Mailing Address - Phone:954-340-9961
Mailing Address - Fax:
Practice Address - Street 1:5258 LINTON BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6540
Practice Address - Country:US
Practice Address - Phone:954-340-9961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1352213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL87703Medicare ID - Type Unspecified
FL5-87703AMedicare ID - Type Unspecified
FL5-87703Medicare ID - Type Unspecified
FLT84652Medicare UPIN